Provider Demographics
NPI:1376302786
Name:ABUNDANT GROWTH COUNSELING PLLC
Entity type:Organization
Organization Name:ABUNDANT GROWTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:810-394-3679
Mailing Address - Street 1:16147 HAVILAND BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8742
Mailing Address - Country:US
Mailing Address - Phone:810-394-3679
Mailing Address - Fax:
Practice Address - Street 1:110 TREALOUT DR STE 105
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3211
Practice Address - Country:US
Practice Address - Phone:810-394-3679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty